254
Unit 3
Applying concepts from the nursing process
is responsible for the severe inflammatory reaction as well as
the ability of these drugs to bind to tissue DNA.
Sloughing and ulceration of the tissue may be so severe that
skin grafting may be necessary. The full extent of tissue damage
may take several weeks to become apparent. Cytotoxic agents
classified as vesicants include some of the most commonly used
agents: cisplatin, dactinomycin, daunorubicin, doxorubicin,
nitrogen mustard, mitomycin, paclitaxel, vinblastine, vincris-
tine and vindesine (Sauerland et al., 2006).
Only specially trained doctors and nurses should administer
vesicants. Careful selection of peripheral veins, skilled veni-
puncture and careful administration of cytotoxic agents are
essential. Indications of extravasation during administration of
vesicant agents include the following:
•
Absence of blood return from the intravenous catheter
•
Resistance to flow of intravenous fluid
•
Swelling, pain, or redness at the site.
Institutional nursing policies should be available to identify
nursing intervention, and an extravasation kit should be
readily available with all of the emergency equipment and
antidote medication as well as a quick reference for how to
properly manage an extravasation of the specific vesicant agent
used. Application of heat or cold is very dependent on the drug
administered, and nurses should refer to their hospital policy.
In general, cold compresses are indicated for doxorubicin
haematological, hepatic, renal, cardiovascular, gastrointestinal
and pulmonary systems are critical in evaluating the response
to chemotherapy (Duong & Loh, 2006; Nirenberg et al., 2006).
Chemotherapy treatment regimens include standard dosage
therapy, dose-dense regimens, and myeloablative regimens
with bone marrow or peripheral stem cell transplant. For
certain chemotherapeutic agents, there is a maximum lifetime
dose limit that must be adhered to because of the danger of
long-term irreversible organ complications (e.g. because of
the risk of cardiomyopathy, doxorubicin [Adriamycin] has a
cumulative lifetime dose limit of 550 mg/m
2
.
Extravasation
Antineoplastic chemotherapeutic agents are additionally clas-
sified by their potential to damage soft tissue if they inadver-
tently leak from a vein (
extravasation
). The consequences
of extravasation range from mild discomfort to severe tissue
destruction, depending on whether the agent is classified as
a non-vesicant, irritant or vesicant. Irritant agents induce
inflammatory reactions but usually cause no permanent tissue
damage.
Vesicants
are those agents that, if deposited into
the subcutaneous tissue (extravasation), cause tissue necrosis
and damage to underlying tendons, nerves and blood vessels.
Although the complete mechanism of tissue destruction is
unclear, it is known that the pH of many antineoplastic drugs
PHARMACOLOGY
Investigational antineoplastic therapies and clinical trials
CHART
11-5
Evaluation of the effectiveness and toxic potential of promising
new modalities for preventing, diagnosing and treating
cancer is accomplished through clinical trials. Before new
chemotherapy agents are approved for clinical use, they
are subjected to rigorous and lengthy evaluations to identify
beneficial effects, adverse effects and safety.
• Phase I clinical trials determine optimal dosing, scheduling
and toxicity.
• Phase II trials determine effectiveness with specific tumour
types and further define toxicities. Participants in these
early trials are most often those who have not responded to
standard forms of treatment. Because phase I and II trials
may be viewed as last-chance efforts, patients and families
are fully informed about the experimental nature of the trial
therapies. Although it is hoped that investigational therapy
will effectively treat the disease, the purpose of early phase
trials is to gather information concerning maximal tolerated
doses, adverse effects and effects of the antineoplastic
agents on tumour growth.
• Phase III clinical trials establish the effectiveness of new
medications or procedures as compared with conventional
approaches. Nurses may assist in the recruitment, consent
and education processes for patients who participate.
In many cases, nurses are instrumental in monitoring
adherence, assisting patients to adhere to the parameters
of the trial and documenting data describing patients’
responses. The physical and emotional needs of patients
in clinical trials are addressed in much the same way as
those of patients who receive standard forms of cancer
treatment.
• Phase IV testing further investigates medications in terms of
new uses, dosing schedule and toxicities.
HOME CARE CHECKLIST
Chemotherapy administration
At the completion of the home care instruction, the patient or carer will be able to:
patient
carer
• Demonstrate how to administer the chemotherapy agent in the home.
4
4
• Demonstrate safe disposal of needles, syringes, IV supplies or unused chemotherapy medications.
4
4
• List possible side effects of chemotherapeutic agents.
4
4
• List complications of medications necessitating a call to the nurse or doctor.
4
4
• List complications of medications necessitating a visit to the emergency department.
4
4
• List names and telephone numbers of resource personnel involved in care (i.e. community nurse,
infusion services, IV vendor).
4
4
• Explain treatment plan (protocol) and importance of follow-up visits to doctor.
4
4
CHART
11-6
